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How did you first learn about (product)?
 
Advertisement
 
Newspaper or magazine article
 
Trade show
 
Search engine
 
Company website
 
Internet chat/list
 
Referral
 
Other
 
 
 
What originally caught your attention about (product) and caused you to inquire about (product)?
   
 
 
 
When you contacted the company about (product), were you seeking a specific solution to a business need or problem? If so, what?
   
 
 
 
If you could change the product to make it valuable enough for you to purchase, how would you change it?
   
 
 
 
When you received the information you requested, did you read it?
 
Yes
 
No
 
 
 
What was the main reason you did not purchase (product)?
 
Already purchased a different product
 
No longer needed the product
 
Technical reason not use the product
 
Put off the purchase for a future time
 
Am still considering the product
 
Other
 
 
 
Which one of the following products did you purchase instead of (product)?
 
Product A
 
Product B
 
Product C
 
Product D
 
Product E
 
Product F
 
Product G
 
Other
 
 
 
Please describe the main reasons you purchased our competitor's product. What did it offer you that (product) did not?
   
 
 
 
Did anyone else influence your buying decision?
 
Yes
 
No
 
 
 
If yes, how was the influential person related to you and what did they say or do that influenced you?
   
 
 
 
What is your position in your business?
 
President or CEO
 
VP
 
Manager
 
Professional
 
 
 
Are you an owner of the business?
 
Yes
 
No
 
 
 
What type of business is it?
   
 
 
 
How long have you been in business?
 
Starting up now
 
1 year or less
 
2-3 years
 
3-5 years
 
5-10 years
 
More than 10 years
 
 
 
How many people does the business employ?
 
Less than 5
 
5-10
 
10-20
 
20-50
 
50-100
 
100 or more
 
 
 
Which of the following best describes your business facilities?
 
Home office
 
Small office (outside the home - less than 25 people)
 
Large office (more than 25 people) or multiple offices
 
Single store
 
Multiple-stores
 
Service facility or distribution warehouse
 
Manufacturing facility
 
Multi-level marketing network of mostly home-based people
 
 
 
In what general range is the company's annual sale revenue?
 
Under $25,000
 
$25,000 - $50,000
 
$50,000 - $150,000
 
$150,000 - $300,000
 
$300,000 - $500,000
 
$500,000 - $1,000,000
 
$1,000,000 - $5,000,000
 
Over $5,000,000
 
 
 
Name:
   
 
 
 
Address:
   
 
 
 
City:
   
 
 
 
Address:
   
 
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